[Prognostic value of noninvasive coronary plaque burden quantification in patients with risk factors]

Non-invasive quantitative indices of atherosclerosis are promising new parameters for an improved prognostic stratification of patients with risk factors that aim at individualized risk factor assessment and modification. In a recently published ACC/AHA consensus document, further data on the diagnostic and prognostic value of coronary calcified plaque quantification were strongly encouraged prior to its use in the general population. In this present work we summarize data published since, which contribute significantly to the prognostic value of fast CT-based noninvasive coronary calcified plaque quantification. It is a measure of atherosclerostic disease activity and is hence an index for the likelihood of future cardiovascular events. Current data indicate that noninvasive quantification of coronary atherosclerosis has incremental prognostic value beyond conventional single risk factor assessment. However, it is not clear yet whether it has a significant value beyond quantitative combined risk assessment using complex risk prediction models such as Framingham charts. Results from ongoing prospective trials such as the MESA study in the US and the Heinz Nixdorf Recall study in Germany will clarify some of the pending issues. In addition, it is still unclear, at what stage of the disease process, which of the available imaging tools will provide optimal diagnostic and prognostic value for the individual patient.